There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
The FDA Drug Labels for calcium (IV) do not address this question.
From the Research
Calcium Supplementation During Plasma Exchange
- The need for calcium supplementation during plasma exchange (plasmapheresis) has been investigated in several studies 1, 2, 3, 4, 5.
- A study from 1986 found that the reduction in serum concentrations of total calcium, ionized calcium, magnesium, and phosphate during plasma exchange was less than predicted, and that parathyroid hormone (PTH) levels increased rapidly to compensate for the reduction in serum calcium levels 1.
- In contrast, a study from 1994 found that prophylactic administration of calcium reduced the incidence of hypocalcemic symptoms from 9.1% to 1% 2.
- Another study from 2018 compared two methods of calcium gluconate infusion and found that both methods prevented a symptomatic fall in plasma ionized calcium during therapeutic plasma exchange, but that one method required significantly less calcium gluconate 3.
- A study from 2011 reported persistent hypocalcemia in patients undergoing therapeutic plasma exchange to reduce HLA antibody levels, despite aggressive calcium repletion 4.
- A study from 2019 found that infusing calcium gluconate at a rate of 1.6 g/h stabilized plasma ionized calcium and prevented hypocalcemic reactions during therapeutic plasma exchange 5.
Key Findings
- Calcium supplementation may not be necessary in patients with normal parathyroid function 1.
- Prophylactic administration of calcium can reduce the incidence of hypocalcemic symptoms 2.
- Different methods of calcium gluconate infusion can be effective in preventing hypocalcemic reactions 3.
- Persistent hypocalcemia can occur in patients undergoing therapeutic plasma exchange, despite calcium supplementation 4.
- Optimizing the infusion rate of calcium gluconate can help prevent hypocalcemic reactions 5.